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{{Tricuspid stenosis}}
{{Tricuspid stenosis}}
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{{CMG}}; {{AE}} [[User:Mohammed Salih|Mohammed Salih, M.D.]] {{sali}} {{Rim}}


==Overview==
==Overview==
The most common cause of tricuspid stenosis is [[rheumatic heart disease]]. Other causes of [[tricuspid stenosis]] include [[carcinois syndrome]], [[congenital]] abnormalities, endocarditis, [[lupus]], and mechanical obstruction by a [[tumor]].
The most common cause of [[tricuspid stenosis]] (TS) is [[rheumatic heart disease]]. Other causes of [[tricuspid stenosis]] include [[carcinoid syndrome]], [[congenital]] abnormalities, [[endocarditis]], [[lupus]], and mechanical obstruction by a [[tumor]].


==Causes of Tricuspid Stenosis==
==Causes==
There are at least 4 conditions that are typically attributed with the obstruction of the native[[ tricuspid valve]].
===Common Causes===
*[[Rheumatic heart disease]] is one of the most common causes of TS and almost always occurs in conjunction with [[mitral stenosis]].<ref name="pmid18628928">{{cite journal |vauthors=Roberts WC, Ko JM |title=Some observations on mitral and aortic valve disease |journal=Proc (Bayl Univ Med Cent) |volume=21 |issue=3 |pages=282–99 |date=July 2008 |pmid=18628928 |pmc=2446420 |doi=10.1080/08998280.2008.11928412 |url=}}</ref><ref name="pmid19065003">{{cite journal| author=Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP et al.| title=Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. | journal=Eur J Echocardiogr | year= 2009 | volume= 10 | issue= 1 | pages= 1-25 | pmid=19065003 | doi=10.1093/ejechocard/jen303 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19065003  }} </ref><ref name="pmid7720297">{{cite journal| author=Waller BF, Howard J, Fess S| title=Pathology of tricuspid valve stenosis and pure tricuspid regurgitation--Part I. | journal=Clin Cardiol | year= 1995 | volume= 18 | issue= 2 | pages= 97-102 | pmid=7720297 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7720297  }} </ref>
*Large [[Vegetation (pathology)|vegetations]] in [[infective endocarditis]] can cause relative [[stenosis]].
*[[Carcinoid syndrome]] may cause isolated TS or mixed with the regurgitant [[lesion]].<ref name="pmid7681733">{{cite journal |vauthors=Pellikka PA, Tajik AJ, Khandheria BK, Seward JB, Callahan JA, Pitot HC, Kvols LK |title=Carcinoid heart disease. Clinical and echocardiographic spectrum in 74 patients |journal=Circulation |volume=87 |issue=4 |pages=1188–96 |date=April 1993 |pmid=7681733 |doi=10.1161/01.cir.87.4.1188 |url=}}</ref>
*Systemic diseases like [[systemic lupus erythematosus]] ([[SLE]]), [[Antiphospholipid syndrome|antiphospholipid antibody]] (APLA) syndrome and the presence of permanent pacing and fusion of [[implantable cardioverter defibrillator]] leads to sub-[[valvular]] structures can cause [[tricuspid stenosis]].<ref name="pmid24661289">{{cite journal |vauthors=Gur AK, Odabasi D, Kunt AG, Kunt AS |title=Isolated tricuspid valve repair for Libman-Sacks endocarditis |journal=Echocardiography |volume=31 |issue=6 |pages=E166–8 |date=July 2014 |pmid=24661289 |doi=10.1111/echo.12558 |url=}}</ref><ref name="pmid26283605">{{cite journal |vauthors=Al-Hijji M, Yoon Park J, El Sabbagh A, Amin M, Maleszewski JJ, Borgeson DD |title=The Forgotten Valve: Isolated Severe Tricuspid Valve Stenosis |journal=Circulation |volume=132 |issue=7 |pages=e123–5 |date=August 2015 |pmid=26283605 |doi=10.1161/CIRCULATIONAHA.115.016315 |url=}}</ref>
*[[Benign tumors]] like [[Atrial myxoma|atrial myxomas]] can cause functional TS<ref name="pmid26272962">{{cite journal |vauthors=Şaşkın H, Düzyol Ç, Özcan KS, Aksoy R |title=Right atrial myxoma mimicking tricuspid stenosis |journal=BMJ Case Rep |volume=2015 |issue= |pages= |date=August 2015 |pmid=26272962 |pmc=4550937 |doi=10.1136/bcr-2015-210818 |url=}}</ref>.
*[[Blunt trauma]] has also been described as a [[risk factor]]. [[Renal]] and [[ovarian tumor]]<nowiki/>[[Ovarian tumor|s]] can grow into the [[tricuspid]] [[orifice]] causing [[stenosis]].


# Rheumatic tricuspid stenosis:
===Less Common Causes===
#* Diffuse thickening of the leaflets occur. Fusion of the commissures may or may not occur.
#* Chordae tendineae may become thickened and shortened
#* As a result of the dense collagen and elastic fibers that make up leaflet tissue, the normal leaflet layers become significantly distorted
# Carcinoid heart disease:
#* Fibrous white plaques located on the valvular and mural endocardium are characteristic presentations of carcinoid valve lesions
#* Valve leaflets become thick, rigid and smaller in area
#* Atrial and ventricular surfaces of the valve structure contain fibrous tissue proliferation
# Congenital tricuspid stenosis:
#* More common in infants
#* Lesions may present in a number of different ways, either singularly or in any combination of the following:
#** Incompletely developed leaflets
#** Shortened or malformed chordae
#** Small annuli
#** Papillary muscles of abnormal size and number
# Infective endocarditis:
#* Stenosis may develop as a result of large infected vegetation obstructing the opening of the tricuspid valve
#* This condition is uncommon


* Unusual and rare causes:
*Other less common causes of TS include [[congenital abnormalities]] ([[Ebstein’s anomaly]]), [[metabolic]] or [[enzymatic]] abnormalities ([[Fabry's disease|Fabry’s]] disease, [[Whipple's triad|Whipple’s]] disease).<ref name="pmid7720297">{{cite journal |vauthors=Waller BF, Howard J, Fess S |title=Pathology of tricuspid valve stenosis and pure tricuspid regurgitation--Part I |journal=Clin Cardiol |volume=18 |issue=2 |pages=97–102 |date=February 1995 |pmid=7720297 |doi=10.1002/clc.4960180212 |url=}}</ref><ref name="pmid22964066">{{cite journal |vauthors=Khatib N, Blumenfeld Z, Bronshtein M |title=Early prenatal diagnosis of tricuspid stenosis |journal=Am. J. Obstet. Gynecol. |volume=207 |issue=5 |pages=e6–8 |date=November 2012 |pmid=22964066 |doi=10.1016/j.ajog.2012.08.030 |url=}}</ref>
** Fabry disease
*Sometimes described are intravenous [[leiomyomatosis]], ventriculoatrial shunts causing TS.<ref name="pmid20824751">{{cite journal |vauthors=Akram Q, Saravanan D, Levy R |title=Valvuloplasty for tricuspid stenosis caused by a ventriculoatrial shunt |journal=Catheter Cardiovasc Interv |volume=77 |issue=5 |pages=722–5 |date=April 2011 |pmid=20824751 |doi=10.1002/ccd.22745 |url=}}</ref><ref name="pmid15226964">{{cite journal |vauthors=Nili M, Liban E, Levy MJ |title=Tricuspid stenosis due to intravenous leiomyomatosis--a call for caution: case report and review of the literature |journal=Tex Heart Inst J |volume=9 |issue=2 |pages=231–5 |date=June 1982 |pmid=15226964 |pmc=351617 |doi= |url=}}</ref>
** Giant blood cysts
*Valvulopathy associated with drugs like [[fenfluramine]]/[[phentermine]] and [[methysergide]] is characterized by thickened fibrotic and hypomobile [[tricuspid]] leaflets, with various degrees of [[valve]] [[stenosis]] and [[regurgitation]].<ref name="pmid21365261">{{cite journal |vauthors=Muraru D, Badano LP, Sarais C, Soldà E, Iliceto S |title=Evaluation of tricuspid valve morphology and function by transthoracic three-dimensional echocardiography |journal=Curr Cardiol Rep |volume=13 |issue=3 |pages=242–9 |date=June 2011 |pmid=21365261 |doi=10.1007/s11886-011-0176-3 |url=}}</ref>


* Other conditions may mimic tricuspid stenosis, obstructing flow through the valve:
===Causes by Organ System===
** Supravalvular obstruction from congenital diaphragms
 
** Intracardiac or extracardiac tumors
{|style="width:80%; height:100px" border="1"
** Thrombosis or emboli
| style="width:25%" bgcolor="lightsteelblue" ; border="1" |'''Cardiovascular'''
** Large endocarditis vegetations
| style="width:75%" bgcolor="beige" ; border="1" | [[Congenital heart disease]], [[cardiac tumor]], [[saphenous vein]] bypass graft [[aneurysm]], [[Ebstein's anomaly]], [[endomyocardial fibrosis]], [[infective endocarditis]], [[myxoma]], [[rheumatic heart disease]].<ref name="pmidPMID: 27217436">{{cite journal| author=Jellis CL, Navia JL, Flamm SD, Rodriguez LL| title=Severe Functional Tricuspid Stenosis Secondary to a Giant Saphenous Vein Bypass Graft Aneurysm. | journal=Circulation | year= 2016 | volume= 133 | issue= 21 | pages= 2099-102 | pmid=PMID: 27217436 | doi=10.1161/CIRCULATIONAHA.115.014772 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27217436  }} </ref>
** Other conditions that impair right-sided filling
|-
*** Constrictive pericarditis
| bgcolor="lightsteelblue" | '''Chemical/Poisoning'''
*** Restrictive Cardiomyopathy
| bgcolor="beige" | No underlying causes
|-
|- bgcolor="lightsteelblue"
| '''Dental'''
| bgcolor="beige" | No underlying causes
|-
|- bgcolor="lightsteelblue"
| '''Dermatologic'''
| bgcolor="beige" | No underlying causes
|-
|- bgcolor="lightsteelblue"
| '''Drug Side Effect'''
| bgcolor="beige" | [[Methysergide]]
|-
|- bgcolor="lightsteelblue"
| '''Ear Nose Throat'''
| bgcolor="beige" | No underlying causes
|-
|- bgcolor="lightsteelblue"
| '''Endocrine'''
| bgcolor="beige" | [[Carcinoid syndrome]]
|- bgcolor="lightsteelblue"
| '''Environmental'''
| bgcolor="beige" | No underlying causes
|-
|- bgcolor="lightsteelblue"
| '''Gastroenterologic'''
| bgcolor="beige" | No underlying causes
|- bgcolor="lightsteelblue"
| '''Genetic'''
| bgcolor="beige" | No underlying causes
|-
|- bgcolor="lightsteelblue"
| '''Hematologic'''
| bgcolor="beige" | No underlying causes
|-
|- bgcolor="lightsteelblue"
| '''Iatrogenic'''
| bgcolor="beige" | [[Pacemaker|Pacemaker infection]], [[pacemaker|pacemaker leads]]<ref name="pmid16800373">{{cite journal| author=Taira K, Suzuki A, Fujino A, Watanabe T, Ogyu A, Ashikawa K| title=Tricuspid valve stenosis related to subvalvular adhesion of pacemaker lead: a case report. | journal=J Cardiol | year= 2006 | volume= 47 | issue= 6 | pages= 301-6 | pmid=16800373 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16800373  }} </ref>, device closure of right coronary arteriovenous fistula.<ref name="pmidPMID: 26603866">{{cite journal| author=Changchien C, Lin MT, Wang CC, Liu HM, Wang CC, Chiu SN et al.| title=Neonatal tricuspid stenosis caused by device closure of a large coronary fistula. | journal=EuroIntervention | year= 2015 | volume= 11 | issue= 7 | pages= e1 | pmid=PMID: 26603866 | doi=10.4244/EIJV11I7A162 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26603866  }} </ref>
|-
|- bgcolor="lightsteelblue"
| '''Infectious Disease'''
| bgcolor="beige" | [[Infective endocarditis]]
|-
|- bgcolor="lightsteelblue"
| '''Musculoskeletal/Orthopedic'''
| bgcolor="beige" | No underlying causes
|-
|- bgcolor="lightsteelblue"
| '''Neurologic'''
| bgcolor="beige" | No underlying causes
|-
|- bgcolor="lightsteelblue"
| '''Nutritional/Metabolic'''
| bgcolor="beige" | [[Fabry disease]], [[Whipple's disease]]
|-
|- bgcolor="lightsteelblue"
| '''Obstetric/Gynecologic'''
| bgcolor="beige" | No underlying causes
|-
|- bgcolor="lightsteelblue"
| '''Oncologic'''
| bgcolor="beige" | [[Carcinoid syndrome]], [[cardiac tumor]], [[intravenous leiomyomatous tumor]],<ref name="pmid15226964">{{cite journal| author=Nili M, Liban E, Levy MJ| title=Tricuspid stenosis due to intravenous leiomyomatosis--a call for caution: case report and review of the literature. | journal=Tex Heart Inst J | year= 1982 | volume= 9 | issue= 2 | pages= 231-5 | pmid=15226964 | doi= | pmc=PMC351617 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15226964  }} </ref> [[metastatic tumor]], [[myxoma]]
|-
|- bgcolor="lightsteelblue"
| '''Ophthalmologic'''
| bgcolor="beige" | No underlying causes
|-
|- bgcolor="lightsteelblue"
| '''Overdose/Toxicity'''
| bgcolor="beige" | No underlying causes
|-
|- bgcolor="lightsteelblue"
| '''Psychiatric'''
| bgcolor="beige" | No underlying causes
|-
|- bgcolor="lightsteelblue"
| '''Pulmonary'''
| bgcolor="beige" | No underlying causes
|- bgcolor="lightsteelblue"
| '''Renal/Electrolyte'''
| bgcolor="beige" | No underlying causes
|-
|- bgcolor="lightsteelblue"
| '''Rheumatology/Immunology/Allergy'''
| bgcolor="beige" | [[Amyloidosis]],<ref name="pmid24797117">{{cite journal| author=Kim KH, Park CH, Park HS, Kim YR, Choi EY| title=Amyloidosis-induced tricuspid stenosis mimicking rheumatic heart disease. | journal=Eur Heart J Cardiovasc Imaging | year= 2014 | volume= 15 | issue= 10 | pages= 1167 | pmid=24797117 | doi=10.1093/ehjci/jeu075 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24797117  }} </ref> [[systemic lupus erythematosus]]
|- bgcolor="lightsteelblue"
| '''Sexual'''
| bgcolor="beige" | No underlying causes
|-
|- bgcolor="lightsteelblue"
| '''Trauma'''
| bgcolor="beige" | No underlying causes
|- bgcolor="lightsteelblue"
| '''Urologic'''
| bgcolor="beige" | No underlying causes
|-
|- bgcolor="lightsteelblue"
| '''Miscellaneous'''
| bgcolor="beige" | [[Cyst|Giant blood cyst]]
|-
|}
 
===Causes by Alphabetical Order===
* [[Amyloidosis]]<ref name="pmid24797117">{{cite journal| author=Kim KH, Park CH, Park HS, Kim YR, Choi EY| title=Amyloidosis-induced tricuspid stenosis mimicking rheumatic heart disease. | journal=Eur Heart J Cardiovasc Imaging | year= 2014 | volume= 15 | issue= 10 | pages= 1167 | pmid=24797117 | doi=10.1093/ehjci/jeu075 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24797117  }} </ref>
* [[Carcinoid syndrome]]
* [[Cardiac tumor]]
* [[Congenital heart disease]]
* [[Ebstein's anomaly]]
* [[Endomyocardial fibrosis]]
* [[Fabry disease]]
* [[Cyst|Giant blood cyst]]
* [[Infective endocarditis]]
*[[Intravenous leiomyomatous tumor]]<ref name="pmid15226964">{{cite journal| author=Nili M, Liban E, Levy MJ| title=Tricuspid stenosis due to intravenous leiomyomatosis--a call for caution: case report and review of the literature. | journal=Tex Heart Inst J | year= 1982 | volume= 9 | issue= 2 | pages= 231-5 | pmid=15226964 | doi= | pmc=PMC351617 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15226964  }} </ref>
* [[Metastatic tumor]]
* [[Myxoma]]
* [[Pacemaker|Pacemaker infection]]
* [[Pacemaker|Pacemaker leads]]
* [[Rheumatic heart disease]]
* [[Systemic lupus erythematosus]]
* [[Whipple's disease]]


==References==
==References==

Latest revision as of 21:30, 1 April 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Salih, M.D. Syed Musadiq Ali M.B.B.S.[2] Rim Halaby, M.D. [3]

Overview

The most common cause of tricuspid stenosis (TS) is rheumatic heart disease. Other causes of tricuspid stenosis include carcinoid syndrome, congenital abnormalities, endocarditis, lupus, and mechanical obstruction by a tumor.

Causes

Common Causes

Less Common Causes

Causes by Organ System

Cardiovascular Congenital heart disease, cardiac tumor, saphenous vein bypass graft aneurysm, Ebstein's anomaly, endomyocardial fibrosis, infective endocarditis, myxoma, rheumatic heart disease.[12]
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect Methysergide
Ear Nose Throat No underlying causes
Endocrine Carcinoid syndrome
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic No underlying causes
Hematologic No underlying causes
Iatrogenic Pacemaker infection, pacemaker leads[13], device closure of right coronary arteriovenous fistula.[14]
Infectious Disease Infective endocarditis
Musculoskeletal/Orthopedic No underlying causes
Neurologic No underlying causes
Nutritional/Metabolic Fabry disease, Whipple's disease
Obstetric/Gynecologic No underlying causes
Oncologic Carcinoid syndrome, cardiac tumor, intravenous leiomyomatous tumor,[10] metastatic tumor, myxoma
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal/Electrolyte No underlying causes
Rheumatology/Immunology/Allergy Amyloidosis,[15] systemic lupus erythematosus
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous Giant blood cyst

Causes by Alphabetical Order

References

  1. Roberts WC, Ko JM (July 2008). "Some observations on mitral and aortic valve disease". Proc (Bayl Univ Med Cent). 21 (3): 282–99. doi:10.1080/08998280.2008.11928412. PMC 2446420. PMID 18628928.
  2. Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP; et al. (2009). "Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice". Eur J Echocardiogr. 10 (1): 1–25. doi:10.1093/ejechocard/jen303. PMID 19065003.
  3. 3.0 3.1 Waller BF, Howard J, Fess S (1995). "Pathology of tricuspid valve stenosis and pure tricuspid regurgitation--Part I." Clin Cardiol. 18 (2): 97–102. PMID 7720297.
  4. Pellikka PA, Tajik AJ, Khandheria BK, Seward JB, Callahan JA, Pitot HC, Kvols LK (April 1993). "Carcinoid heart disease. Clinical and echocardiographic spectrum in 74 patients". Circulation. 87 (4): 1188–96. doi:10.1161/01.cir.87.4.1188. PMID 7681733.
  5. Gur AK, Odabasi D, Kunt AG, Kunt AS (July 2014). "Isolated tricuspid valve repair for Libman-Sacks endocarditis". Echocardiography. 31 (6): E166–8. doi:10.1111/echo.12558. PMID 24661289.
  6. Al-Hijji M, Yoon Park J, El Sabbagh A, Amin M, Maleszewski JJ, Borgeson DD (August 2015). "The Forgotten Valve: Isolated Severe Tricuspid Valve Stenosis". Circulation. 132 (7): e123–5. doi:10.1161/CIRCULATIONAHA.115.016315. PMID 26283605.
  7. Şaşkın H, Düzyol Ç, Özcan KS, Aksoy R (August 2015). "Right atrial myxoma mimicking tricuspid stenosis". BMJ Case Rep. 2015. doi:10.1136/bcr-2015-210818. PMC 4550937. PMID 26272962.
  8. Khatib N, Blumenfeld Z, Bronshtein M (November 2012). "Early prenatal diagnosis of tricuspid stenosis". Am. J. Obstet. Gynecol. 207 (5): e6–8. doi:10.1016/j.ajog.2012.08.030. PMID 22964066.
  9. Akram Q, Saravanan D, Levy R (April 2011). "Valvuloplasty for tricuspid stenosis caused by a ventriculoatrial shunt". Catheter Cardiovasc Interv. 77 (5): 722–5. doi:10.1002/ccd.22745. PMID 20824751.
  10. 10.0 10.1 10.2 Nili M, Liban E, Levy MJ (June 1982). "Tricuspid stenosis due to intravenous leiomyomatosis--a call for caution: case report and review of the literature". Tex Heart Inst J. 9 (2): 231–5. PMC 351617. PMID 15226964.
  11. Muraru D, Badano LP, Sarais C, Soldà E, Iliceto S (June 2011). "Evaluation of tricuspid valve morphology and function by transthoracic three-dimensional echocardiography". Curr Cardiol Rep. 13 (3): 242–9. doi:10.1007/s11886-011-0176-3. PMID 21365261.
  12. Jellis CL, Navia JL, Flamm SD, Rodriguez LL (2016). "Severe Functional Tricuspid Stenosis Secondary to a Giant Saphenous Vein Bypass Graft Aneurysm". Circulation. 133 (21): 2099–102. doi:10.1161/CIRCULATIONAHA.115.014772. PMID 27217436 PMID: 27217436 Check |pmid= value (help).
  13. Taira K, Suzuki A, Fujino A, Watanabe T, Ogyu A, Ashikawa K (2006). "Tricuspid valve stenosis related to subvalvular adhesion of pacemaker lead: a case report". J Cardiol. 47 (6): 301–6. PMID 16800373.
  14. Changchien C, Lin MT, Wang CC, Liu HM, Wang CC, Chiu SN; et al. (2015). "Neonatal tricuspid stenosis caused by device closure of a large coronary fistula". EuroIntervention. 11 (7): e1. doi:10.4244/EIJV11I7A162. PMID 26603866 PMID: 26603866 Check |pmid= value (help).
  15. 15.0 15.1 Kim KH, Park CH, Park HS, Kim YR, Choi EY (2014). "Amyloidosis-induced tricuspid stenosis mimicking rheumatic heart disease". Eur Heart J Cardiovasc Imaging. 15 (10): 1167. doi:10.1093/ehjci/jeu075. PMID 24797117.

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